The healthcare industry is widely recognized as information-intensive and IT is considered to be an intrinsic component of the success of healthcare organizations such as hospitals. While both researchers and practitioners have argued that hospitals should aspire to be IT innovators, most tend to be IT laggards. An understanding of the factors that drive hospitals to become IT innovators remains an important phenomenon of interest. However, there is a lack of theory-driven empirical research that systematically investigates the factors that influence a hospital's strategic choice to be an IT innovator and the influence of IT innovation on hospital performance. This study bridges the extant gaps in the literature by developing and testing an integrated model that seeks to understand why certain hospitals are IT innovators. Using IT innovation theory as our theoretical foundation, we examine three antecedents, including the chief information officer (CIO) strategic leadership, the top management team's (TMT) attitude toward IT, and the hospital's climate. Further, we examine the influence of IT innovation on the impact of IT within the hospital and the influence of IT impact on the hospital's financial performance. The research model was tested using both survey and archival data from 70 matched pairs of hospital CIOs and executives. The quantitative analysis is supplemented with by interviews with 10 participating CIOs to further examine the relationship of the CIO to hospital IT innovation. The results suggest that the CIO strategic leadership and the TMT's attitude toward IT are key factors that influence IT innovation; however, the influence of a hospital's climate on organizational IT innovation is contingent upon the CIO's level of strategic leadership. The results also suggest that hospitals that are IT innovators can generate greater impact from IT, which in turn results in greater performance for the hospital. Theoretical and practical implications as well as future research directions are discussed. © 2010 Elsevier B.V. All rights reserved.